in 2018, the total United States prescription drug expenditures were approximately $335 billion.1 The Centers for Medicare & Medicaid Services predict that prescription drug spending will increase by 22% from 2019 to 2023. Due to continually rising drug costs, it is vital to promote cost-effective clinical decision-making to improve prescribing practices and reduce unnecessary expenses.2 One such intervention found to impact prescribing decisions is academic detailing.

Academic detailing is an interactive educational outreach for health care clinicians that has been in existence since the 1980s.3 Faculty from Harvard University pioneered the model. It combines the communication techniques used by pharmaceutical sales representatives to influence prescribing practices with the noncommercial goals of academic groups.

ACADEMIC DETAILING BENEFITS FOR CLINICIANS
It may take up to 17 years for research to be incorporated into practice.4 It is incredibly challenging for busy clinicians to synthesize current clinical evidence from the continually evolving literature. As a result, sometimes clinicians may have gaps in knowledge regarding appropriate pharmacotherapy. Academic detailing provides clinicians with a nonbiased, accurate source of information about the effectiveness, safety, and cost of pharmaceuticals.5 This approach can be a beneficial way to communicate comparative effectiveness research in an actionable, evidence-based, and balanced manner.

FUNDAMENTAL PRINCIPLES, TECHNIQUES, AND STRUCTURE OF AN EFFECTIVE ACADEMIC DETAILING OUTREACH
Academic detailing programs may target prescribing problems related to polypharmacy, the use of high risk/low benefit medications, and underutilization, as well as cost-ineffective therapies.6 Successful program strategies include defining specific behavioral and educational objectives, targeting clinicians with utilization problems, and enlisting the involvement of clinician opinion leaders in the design and implementation of the educational interventions. Sponsorship of the academic detailing program by respected professional organizations, educational institutions, or expert consultants establish credibility and improve rates of acceptance of outreach.

During an academic detailing visit, trained clinical educators meet 1:1, either in person or virtually, with clinicians to discuss a topic relevant to their practices.7 Some qualities essential to being an effective academic detailer include clear communication skills, excellent motivational interviewing techniques, approachability, innovative thinking, and empathy.8 The outreach consists of several components: introduction, needs assessment, key messages with features and benefits, handling objections, and closing.9 The figure provides an overview of the elements of an academic detailing visit. The visit starts with an introduction.



The introduction sets the scene and conveys the reason for the visit.10 The detailer communicates their personal background, organizational affiliation, the purpose of the program, how the clinician will benefit, and verifies clinician acceptance of the service.

Educational interventions require an understanding of the clinician’s knowledge and rationale for current prescribing habits.6 During the needs assessment portion of the visit, academic detailers use open-ended questions to determine the concerns and beliefs of the clinician to tailor the information to meet their specific needs and gaps in knowledge.10

The academic detailer delivers relevant, targeted practice recommendations, also known as key messages, applicable to the clinician’s practice.10 To reinforce these points, the educator uses concise, easy-to-understand graphic material referencing unbiased sources.6,10 Effective behavioral modification is contingent upon the academic detailer’s ability to link the key messages to the beliefs, values, needs, and interests of the clinician. The detailer will offer proposed actions or features coupled with benefits associated with that behavior change to promote clinician acceptance of key messages.10

It is unlikely that clinicians will always accept or agree with the information presented.10 Objections can signal a misinterpretation of the content, lack of awareness of the need for change, inadequate resources or time to implement change, or disagreement with the information. The detailer can attempt to engage the clinician in a 2-way conversation to understand the reason for the objection and responds with enablers that may address clinician concerns or barriers. Research in adult learning showed that active engagement of the learner was more likely to result in the achievement of desired objectives as well as increased satisfaction.6

During the summary and closing, the academic detailer provides a brief overview of the key messages that the clinician accepted and asks the provider to implement them in their practice.10 Detailers schedule a follow-up appointment to reemphasize key messages from the previous visit and provide positive reinforcement of improved prescribing practices.6 The ultimate goal is to build trust and long-term relationships with clinicians to optimize pharmacotherapy collaboratively.

THE IMPACT OF ACADEMIC DETAILING
A Cochrane systematic review evaluating the effects of academic detailing concluded that educational outreach visits could be effective in improving clinician practices.11 Some recent academic detailing studies have also reaffirmed cost savings and changes in prescribing.12-16 However, the lack of standard implementation of academic detailing and the nonuniform approach to collecting and reporting data hampers the evaluation of the impact of findings.17,18 Many academic detailing programs sponsored by public health departments, academic institutions, insurance companies, and governmental health systems have been successfully implemented in the United States and across the world.19

LEARN MORE ABOUT ACADEMIC DETAILING, TRAINING
The National Resource Center for Academic Detailing (NaRCAD) operates within the Division of Pharmacoepidemiology and Pharmacoeconomics in the Department of Medicine at Brigham and Women’s Hospital.20 Founded in 2010, NaRCAD provides educator training and best practice resources for academic detailers. Its website has educational materials, literature, academic detailing tool kits, webinars, blogs, e-newsletters, podcasts, and connection opportunities through its partner network.

CONCLUSION
Pharmacists receive extensive educational training about the safety, efficacy, and cost-effectiveness of medications. They serve as drug experts for both health care professionals and patients.

Pharmacists with outstanding communication skills are ideally qualified to interpret evidence-based pharmacotherapy information and conduct educational outreach visits with clinicians. Academic detailing is yet another way pharmacist-led interventions may improve medication- related outcomes.
 
LORI UILDRIKS, PHARMD, BCPS, BCGP, is a clinical pharmacist, and clinical instructor for the University of Illinois at Chicago College of Pharmacy, Department of Pharmacy Practice.

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